Occupational therapy in palliative care: Is it under‐utilised in Western Australia?

Aim: To explore potential barriers to occupational therapy in palliative care in Western Australia, as perceived by occupational therapists and other health professionals. Method: A qualitative research methodology was used. Semi‐structured interviews were conducted with 10 occupational therapists and 10 health professionals (including a physiotherapist, a social worker, medical registrars and clinical nurses). Interviews were transcribed verbatim and analysed using content analysis. Results: The four main themes identified were: inconsistent understanding of the contribution that occupational therapists can make to palliative care, insufficient promotion of the potential contribution of occupational therapy, insufficient funding, and limited research on the role of occupational therapy in palliative care. Conclusion: This study provides an understanding of the barriers that have limited occupational therapists’ involvement in providing palliative care in Western Australia.     

Is there a place for sexuality in the holistic care of patients in the palliative care phase of life?

Being diagnosed with a life-limiting condition is a traumatic event. The journey to the moment of death is usually only done once--so it is a time of fears and uncertainty. Sexuality is particularly vulnerable at this time. It may be difficult for both patient and partner to deal with the changes in sexuality without professional assistance. It is "sexuality" rather than "sex" that defines the meaningful relationships people have with themselves and significant others. When sexuality is lost or changed, important benefits may be lost. Studies show that many patients do value sexuality and want assistance in making the best of their sexual potential during the palliative care phase. Health professionals regularly acknowledge the importance of sexuality for their patients but have difficulties acting on their beliefs. Sexuality, within the patient's functional ability and desire for it, must be acknowledged and included in holistic management. It is the health professional's responsibility to raise this issue.     

Is it appropriate to screen palliative care patients for depression?

It is estimated that approximately 25 percent of palliative care patients have symptoms of depression, but much of this depression is not identified and therefore not treated. Reasons for nonidentification include the difficulties of distinguishing between what can be called "appropriate sadness" and depression at the end of life and also the nondisclosure by patients of their own mood. In an effort to improve the early detection of depression, patients of all age groups referred to a clinical nurse specialist team within a six-month period were invited to complete the Edinburgh Postnatal Depression Scale (EPDS); the scale was found in an earlier study to have a sensitivity and specificity of above 80 percent at a cutoff threshold of 13 or above. The present study found that 34 percent of patients scored at or above the previously validated threshold of 13, and that younger patients (under age 50) were twice as likely to score above the threshold than were older patients (over age 70). The scale was easy to complete by patients, and staff found it useful as part of their initial assessment of patients. It is suggested that such a tool may aid the early detection and treatment of depression in palliative care patients.     

Ziconotide: can we use it in palliative care?

Ziconotide (PRIALT) is a new nonopioid treatment for chronic pain. It is a peptide that is the synthetic analog of the omega-conotoxin, derived from the marine snail, Conus magus. The therapeutic benefit of ziconotide derives from its potent and selective blockade of neuronal N-type voltage-sensitive calcium channels. Interference with these channels inhibits input from pain-sensing primary nociceptors. A recent clinical trial demonstrated that ziconotide has a significant analgesic effect compared to placebo in patients considered intolerant or refractory to other treatment such as systemic analgesics, adjunctive therapies, or intrathecal (IT) morphine. Thus, ziconotide is the first of a new class of agents--N-type calcium channel blockers, or NCCBs. Ziconotide may represent another option for patients with refractory pain.     

Is social class standardisation appropriate in occupational studies?

Social class standardisation has been proposed as a method for separating the effects of occupation and "social" or "lifestyle" factors in epidemiological studies, by comparing workers in a particular occupation with other workers in the same social class. The validity of this method rests upon two assumptions: (1) that social factors have the same effect in all occupational groups in the same social class, and (2) that other workers in the same social class as the workers being studied are free of occupational risk factors for the disease of interest. These assumptions will not always be satisfied. In particular, the effect of occupation will be underestimated when the comparison group also has job-related exposures which cause the disease under study. Thus, although adjustment for social class may minimise bias due to social factors, it may introduce bias due to unmeasured occupational factors. This difficulty may be magnified when occupational category is used as the measure of social class. Because of this potential bias, adjustment for social class should be done only after careful consideration of the exposures and disease involved and should be based on an appropriate definition of social class. Both crude and standardised results should be presented when such adjustments are made.     

Research in palliative care; is something better than nothing?

How strictly should we apply the rules of good clinical research, when the research in question is performed with terminally ill patients? Recently, a retrospective study into the effectiveness of radiotherapy for sialorrhoea in patients with a degenerative disease, such as amyotrophic lateral sclerosis, was published in the Nederlands Tijdschrift voor Geneeskunde(Dutch Journal of Medicine). This commentary defends the position that in palliative care sometimes having weak scientific evidence is better than having nothing. Here, the need of the patient and the intention of the physician are 2 ethically relevant issues that need to be taken into account. If there is at least some evidence to believe an intervention is beneficial for the patient, this is a strong reason to provide it. And if such intervention can only be studied in a methodologically suboptimal way, then it is better to have that information, albeit not perfect, than none at all. This is not a justification of weak studies as such. If possible, palliative care should be as evidence-based as all other types of medical care. However, when the circumstances make methodologically perfect research impossible, it is better to act on weak evidence than on none at all.     

Death without distress? The taboo of suffering in palliative care

Medicine, Health Care and Philosophy - Palliative care (PC) names as one of its central aims to prevent and relieve suffering. Following the concept of “total pain”, which was first...     

Untaming grief ? For palliative care physicians

Little doubt (if any) remains as to the assured importance of physicians possessing praxis regarding psychosocial issues, including grief dynamics, in order to tend to dying and sorrowing people. It stands to reason then that palliative care physicians become knowledgeable enough about the phenomenon of grief. But imperative nuances must also be considered: what sort of knowledge on grief, as well as how much of such knowledge, is enough? This article poses topical queries on the importance of the palliative care physician exercising a deliberate agenda to persistently refine one's personal framework or beliefs regarding grief. In doing so, it is proposed physicians will engender improved self-knowledge, which will serve to better poise themselves toward being with and purposefully encountering aggrieved others.     

Extending specialist palliative care to all?

How to extend palliative care services to all patients needing them is an issue currently exercising a range of bodies in contemporary Britain. This paper first considers the evidence regarding the needs of dying patients with long term conditions other than cancer and concludes that there is evidence to support their presumed need for palliative care. It then considers five potential barriers to extending specialist palliative care services to non-cancer patients in Britain. These are the skill base of current specialists in palliative care, difficulties in identifying candidates for specialist palliative care, the views of potential users of these services, resource implications and vested interests in present health service arrangements.